As the new year begins and we reflect on 2020, we are faced with the sad reality that almost 4,800 Alabamians have died from COVID-19, the highly contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Last spring when we learned about the illnesses and deaths due to this highly contagious virus, it was almost unimaginable that our state–much of it rural and without the higher population density of Europe and the Northeast–would reach this level of loss.
While we were initially afraid we would reach such high numbers as a worst-case scenario, by now this deadly virus has become a part of almost everyone’s personal experience. Regrettably, I know many people who have been infected, hospitalized, and died.
Although death totals from all causes have not been tallied for 2020, it is apparent that Alabama has exceeded the number of deaths we would expect to experience in a normal year. Every one of those deaths is someone’s fellow citizen, friend, or family member. Skeptics opine that COVID-19 mortality is no worse than the flu, and the number of deaths in 2020 is about the same as it would have been by coincidence due to the number of frail elderly persons in the state. That statement is far from the truth. Fewer than 1,300 people in Alabama succumbed to flu and pneumonia combined in 2018, and COVID-19 has resulted in more than triple the mortality in 2020.
We now have vaccine products and better therapeutic agents for those with the virus. I am optimistic about the future as we embark on a vaccine effort like we have never tried before. Tens of thousands of frontline workers, residents of long-term care, and other very high-risk Alabamians have already received immunizations in cooperation with our community partners.
Many people are interested in receiving COVID-19 vaccine as soon as it is available for their risk group; some are even making demands for it, but equitable distribution of vaccine is critical. We do not yet have a timeline of when priority groups can receive vaccination because we are dependent on vaccine supply. For many people, access will come in the late spring at best.
After the first phases of vaccine administration, however, we will face the complicated challenge of convincing a larger number of people about the safety and effectiveness of COVID-19 vaccine. Many Alabamians are hesitant to be vaccinated for a variety of reasons, including misinformation. Certainly, a segment of the population mistrusts all vaccines and the system in general, and those people are difficult to convince. Many more people have concerns about the technology used to develop and approve the vaccine rapidly; they want to make sure it is safe; and know more about possible side effects before they are immunized. Questions raised by the public are appropriate and we need to be responsive to their concerns.
We must take different approaches to reach all populations in the state by providing clear, accurate, and culturally sensitive information about COVID-19 prevention, treatment, and vaccines. Some segments of the population may be hard to reach. Race history in Alabama is checkered, and opinions are influenced by events like the Tuskegee Syphilis Study. Many African American Alabamians remain unsure whether they can believe what public health tells them. To counteract these longstanding uncertainties and fears, our department is working with members of the African American community, including pastoral organizations, faith leaders, the League of Black Mayors, local public officials, and others. Their trusted voices will carry well-informed, data-driven, and credible messages to their own congregations and constituents.
Despite erroneous reports to the contrary, Alabama does not mandate vaccination. Regardless of vaccine uptake, which we hope will be significant, pandemic protocols must continue to be practiced for many months. Until the majority of the population is vaccinated and more information is available on the vaccines’ ability to stop virus transmission, wearing masks, social distancing, frequent handwashing, avoiding crowded indoor areas, and traveling only when necessary are still needed. Masks serve as a powerful social symbol to remind people to protect themselves and others. We have always known that masks are not magic, but they are effective. The best indication we have is that it only took two weeks for Alabama’s COVID-19 infection rates to decrease after a mask mandate began in July.
As 2021 begins, our deepest sympathies are with the families and friends who have lost loved ones during this pandemic. Anyone can get and spread COVID-19, so it is our responsibility as citizens to be kind to other people and to take all necessary steps to prevent them from being at risk. This includes getting vaccinated, returning for the second dose of vaccine, and following Centers for Disease Control and Prevention recommendations regarding prevention measures. When a substantial portion of the public is vaccinated, we look forward to a time when the pandemic will end.
Scott Harris, M.D.
State Health Officer
